Acute Abdomen

Question 1

Definition

Answer 1

A condition when the patient has acute pain in abdomen for more than 6hours

Question 2

History

Answer 2

Nausea, vomiting, anorexia
• Diarrhea, constipation, flatus, blood, tenesmus
• Menstruation - where in the cycle
sexual activity
• Previous episodes -
relationship to meals:
2 - 2 1/2 hrs = duodenal
worse with food = gastric
fatty foods = gallstones

Question 3

Physical Examination

Answer 3

General appearance -
restlessness = colic immobility
with knees flexed = peritonitis
• Blood pressure
• Pulse - “too optimistic a friend to be relied upon…”
• Respiratory rate - may suggest a thoracic origin
• Temperature - could be normal, high or low >
104oF (40oC) suggests thorax or kidney

PE: Chest
• Inspection
• Palpation
• Percussion
• Auscultation

PE: Abdomen
• Inspection - distention, hernias
DON”T FORGET THE FEMORAL CANAL
• Auscultation
• Palpation - rigidity
area of
greatest pain last
• Percussion - “rebound”, cough tenderness Rosving’s sig

Z PE: Pelvis
• Pelvic examination -
bimanual
• Rectal examination -
mass, tenderness, bloo

Question 4

Laboratory Tests

Answer 4

• CBC - leukocytosis, anemia
• Urinalysis - infection, blood, pregnancy
• Electrolytes - renal function, dehydration
• Amylase, lipase
LFT

Question 5

Perforated Ulcer

Answer 5

Sudden onset
• Previous episodes of pain ~
2 hrs after eating
• CXR - free air

Question 6

Appendicitis

Answer 6

Fecolith
• Young
1. Dull pain in midepigastrium
2. Nausea/vomiting follows pain
3. Localizes to RLQ
* Anorexia
+ Fever
• Leukocytosis

Question 7

Radiographic Studies

Answer 7

Flat & upright abdomen - air-fluid
levels, distended loops, edema in bowel wall, volvulus,
fecolith
• CXR - free air, lower lobe pneumonia
• Contrast studies -
H2O soluble if perforation
disadvantage - aspiration, quality

Question 8

Pancreatitis

Answer 8

Alcohol
• Gallstones
• Trauma
• Hyperlipidemia
• Hyperparathyroidism
• Drugs - thiazide diuretics
• Unknown (10

Excruciating pain
• Fever - almost always
• Ranson’s criteria
• Grey Turner sign
• Cullen’s sign

Question 9

Amylase

Answer 9

• Pancreatitis
• Cholecystitis
• High intestinal obstruction
• Acute renal insufficiency
• Perforated ulcer

Question 10

Cholecystitis

Answer 10

Cholecystitis Radiopaque gallstones (10-15%)
• Pain - RUQ, “colic”, radiates to the ipsalateral
scapula
• Pain brought on with fatty foods
• US - stones, thickening, fluid, air in wa

Question 11

Intestinal Obstruction

Answer 11

pain - colic
• Vomiting, distention
• Obstipation
• Auscultation - quiet to high-pitched, tinkling
rushes to borborygmi
• X-ray - air-fluid levels, fixed loop

Question 12

Female Disorders

Answer 12

• Ectopic pregnancy, PID, mittelschmerz, appendicitis
• Chandelier sign
• Urinalysis
• Ultrasound
• Laparoscop

Question 13

Mesenteric Vascular Occlusion

Answer 13

• Pain out of proportion to physical examination
• Risk factors - atrial fibrillation, digitalis, diuretics, cardiopulmonary bypass
• Barium enema may show “thumbprinting”
• Angiography, MRI
• Mortality = 50%